Building Models for the Relationship Between Attitudes Toward Suicide and Suicidal Behavior: Based on Data from General Population Surveys in Sweden, Norway, and Russia

Abstract

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self-reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self-reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture-specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

“…The higher acceptability of suicide among females found in our study is also found in some, but not all, studies from other countries (Agnew, 1998; Beautrais, Horwood, & Fergusson, 2004; Hjelmeland et al, 2008; Joe, Romer, & Jamieson, 2007; Kocmur & Dernovšek, 2003; Parker, Cantrell, & Demi, 1997; Salander Renberg & Jacobsson, 2003; Zemaitiene & Zaborskis, 2005); the finding in China could be related to the relatively high rate of suicide in Chinese females compared to that in other countries (WHO, 2002). Controversy remains about the relationship of age to attitudes about the acceptability of suicide (Salander Renberg et al, 2008; Salander Renberg & Jacobsson, 2003; Segal, Mincic, Coolidge, & O’Riley, 2004); the decreasing acceptability of suicide as individuals age (after adjusting for educational level) found in our study may be a reflection of an underlying culturally conditioned conservatism that results in increasing intolerance to all forms of social deviance (including suicidal behavior) as one ages. Suicide rates in China, like in most other countries, increase with age (Phillips et al, 2002) so the decreasing acceptability of suicide with age does not appear to substantially reduce the rates of suicidal behavior.…”

“…Prior research has not compared attitudes in different population groups and very few studies employ multivariate analysis to assess the factors independently related to attitudes about suicide (Salander Renberg et al, 2008; Seidlitz et al, 1995), so it is only possible to compare some of our results with prior studies. Similar to our study, most studies from other countries find more accepting attitudes about suicide among those with more education (Salander Renberg & Jacobsson, 2003; Singh, Williams, & Ryther, 1986) so this appears to be a robust relationship cross-nationally.…”

“…Another important component in the complex causal network for suicide is the normative cultural attitudes about suicide, which vary by community, by population cohort, and over time (Salander-Renberg, et al, 2008; Goldsmith et al, 2002). …”

“…Attitudes about suicide are multidimensional, including constructs such as permissiveness, unpredictability, perceived causes, preventability, appropriate management and so forth (Salander-Renberg, et al, 2008). Early beliefs that there was a direct causal link between suicidal behavior and attitudes about suicide (Farberow, 1989) have given way to a more nuanced understanding of the complex interactions between attitudes and behavior.…”

“…For example, research in high-income countries finds that throughout their lifetimes males, Caucaisians, and less religious persons are more accepting of suicide (Deluty, 1988–89; Domino & Miller, 1992; Marks, 1988–89; Overholser, Hemstreet, Spirito, & Vyse, 1989; Salander Renberg, Hjelmeland, & Koposov, 2008; Seidlitz, Duberstein, Cox, & Conwell, 1995; Stein, Witztum, Brom, Denour, & Elizur, 1992) but these findings may not be relevant in China because of differences in the sociodemographic characteristics of suicide and of the general population: unlike in most high-income countries, female suicide rates in China are somewhat higher than male rates (Phillips, Li, & Zhang, 2002), 92% of the population is of the Han ethnicity (National Bureau of Statistics of China, 2001), and (with the exception of some minority groups) a very small proportion of the population have religious beliefs or practices.…”